Researchers: With no AIDS cure, treatment for HIV is best medicine

Eight years ago, Waldon Adams tested HIV-positive. Four years ago, he developed symptoms of AIDS, which meant bouts of pneumonia and weeks-long stays in hospitals and nursing homes. Now, Adams, 51, is healthy enough to run marathons.

Truvada, a newly FDA-approved drug to help prevent HIV infection, is among the AIDS drugs that fill the shelves at the pharmacy at the Whitman-Walker Clinic.
MCT

Eight years ago, Waldon Adams tested HIV-positive. Four years ago, he developed symptoms of AIDS, which meant bouts of pneumonia and weeks-long stays in hospitals and nursing homes. Now, Adams, 51, is healthy enough to run marathons.

“When they found out I was going to run a marathon, I made the news,” said Adams, who receives treatment and support at Whitman-Walker Health, a clinic in Washington that’s helped people with HIV and AIDS in the nation’s capital for nearly three decades.

Adams isn’t cured. However, he’s an example of what’s possible with current treatments for HIV and AIDS, and researchers and advocates who are meeting in Washington this week at the International AIDS Conference say that until a cure is found, that’s the next best thing for the 1.1 million Americans and 34 million people worldwide who have HIV.

“We’re just beginning,” said Steven Deeks, a professor in the University of California, San Francisco, Division of HIV/AIDS at San Francisco General Hospital. “This is going to take many years or decades until we have a really effective available cure.”

An international trial last year by the National Institute of Allergy and Infectious Diseases found that treating people who have HIV but have yet to develop AIDS symptoms made them 96 percent less likely to transmit the disease to their partners. The Food and Drug Administration recently approved Truvada, a drug that not only can help make HIV undetectable in those who have the virus, but also can prevent those who don’t have it from getting infected.

“The ability to prevent and treat the disease has advanced beyond what many might have reasonably hoped 22 years ago,” Secretary of State Hillary Clinton said Monday in a speech to conference delegates. “Yes, AIDS is still incurable, but it no longer has to be a death sentence.”

The optimism is a contrast to the last time the conference came to the United States – in San Francisco in 1990 – when AIDS brought near-certain death. Now, antiretroviral drugs, if properly taken, can reduce HIV in patients to almost undetectable levels.

Former President George W. Bush launched a global effort to treat HIV and AIDS almost a decade ago, and 4 million people in the world’s most affected countries now receive care. A national HIV/AIDS strategy began under President Barack Obama in 2010, with the goal of reducing the number of new U.S. infections. About 50,000 Americans become infected with HIV every year, according to Centers for Disease Control and Prevention estimates.

There are still many challenges. One in five people who have HIV don’t know it, according to the CDC. When they don’t know their status, they’re more likely to transmit the disease to others. And when people find out they have HIV, they need access to treatment – a barrier for the poor and uninsured, because the drugs are expensive. Antiretroviral therapy can cost hundreds, sometimes even thousands, of dollars a month.

This month, the federal Ryan White AIDS Drug Assistance Program, which provides treatment and care to low-income HIV patients, had a waiting list of about 2,000 people in nine states. Last week, Health and Human Services Secretary Kathleen Sebelius announced $80 million in grants to eliminate the backlog and expand the program to thousands of others who need it.

“It’s these larger issues that are the major barriers and why we’re not maximizing the benefit from therapy,” Deeks said. But as long as people continue to become infected with HIV, he said, the cost of not treating them would be even greater.

Michael Kolber, the director of the Comprehensive AIDS Program at the University of Miami School of Medicine, said money spent on treatment could save long-term health care costs, perhaps in the tens of billions of dollars or more.

“Obviously, the drugs have side effects and they’re costly and some people develop drug resistance, but these potential problems are nothing compared to the benefits of therapy,” Deeks said. “The more people get treated, the better.” The side effects include headaches, nausea and vomiting, and long-term complications such as bone loss and kidney and liver problems.

Further, HIV medications work only when people keep taking them. It wasn’t easy for Adams, who said he struggled for years with drug and alcohol addiction.

“It took me a while to get used to it,” he said. “I hate medicine.”

But taking the medication saved his life.

Adams’ story illustrates that people with HIV need not only treatment, but also support. Adams said that in contrast to hospitals, where he was treated like any other patient, staff members at Whitman-Walker literally opened their arms to him. The first time a nurse drew his blood at the clinic, she hugged him.

“That was the first thing I got when I came here. I never forgot that,” Adams said. “I needed that. I was scared.”

Meghan Davies, the director of community health at Whitman-Walker, said that everyone should know his or her HIV status, and that everyone who has HIV should receive treatment.

“We don’t want you to get HIV. It is a difficult disease to have,” she said. “But once you have HIV, we can help you lead a long and healthy life.”

As for a cure? Researchers are reluctant to predict when one might be found.

“We’re all thinking about how to purge the virus from the body, and people believe that that’s possible now. Not today, but in the future sometime,” Kolber said.